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288 Pages·2017·1.58 MB·English
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Edith Cowan University Research Online Theses: Doctorates and Masters Theses 2014 Learning from the experts: Qualitative study of the lived experience of mental illness Zdenka Bartova Edith Cowan University Follow this and additional works at: https://ro.ecu.edu.au/theses Part of the Mental and Social Health Commons, and the Psychology Commons Recommended Citation Bartova, Z. (2014). Learning from the experts: Qualitative study of the lived experience of mental illness. https://ro.ecu.edu.au/theses/1412 This Thesis is posted at Research Online. https://ro.ecu.edu.au/theses/1412 Edith Cowan University Research Online Teses: Doctorates and Masters Teses 2014 Learning from the experts: Qualitative study of the lived experience of mental illness Zdenka Bartova Edith Cowan University Recommended Citation Bartova, Z. (2014). Learning fom the experts: Qualitative study of the lived experience of mental illness. Retrieved from htp://ro.ecu.edu.au/theses/1412 Tis Tesis is posted at Research Online. htp://ro.ecu.edu.au/theses/1412 Edith Cowan University      Copyright Warning            You may print or download ONE copy of this document for the purpose  of your own research or study.    The University does not authorize you to copy, communicate or  otherwise make available electronically to any other person any  copyright material contained on this site.    You are reminded of the following:     Copyright owners are entitled to take legal action against persons  who infringe their copyright.     A reproduction of material that is protected by copyright may be a  copyright infringement. Where the reproduction of such material is  done without attribution of authorship, with false attribution of  authorship or the authorship is treated in a derogatory manner,  this may be a breach of the author’s moral rights contained in Part  IX of the Copyright Act 1968 (Cth).     Courts have the power to impose a wide range of civil and criminal  sanctions for infringement of copyright, infringement of moral  rights and other offences under the Copyright Act 1968 (Cth).  Higher penalties may apply, and higher damages may be awarded,  for offences and infringements involving the conversion of material  into digital or electronic form. USE OF THESIS The Use of Thesis statement is not included in this version of the thesis. Learning from the Experts: Qualitative Study of the Lived Experience of Mental Illness By Zdenka Bartova, B. A. (Hons) A thesis submitted in fulfilment of the requirements for the award of the degree Doctor of Philosophy School of Psychology and Social Science Faculty of Health, Engineering and Science Edith Cowan University October 2014 Abstract Severe mental illness has a profound effect on the affected individuals yet it does not necessarily prevent them from leading a meaningful and fulfilling life, and therefore recovering. Recovery has received a great interest in clinical and consumer research yet little is known about how those individuals who do not primarily identify with recovery respond to the concept and come to accept it as something that is personally meaningful. Using a qualitative approach following the principles of Gadamer’s (1975) hermeneutics, the present study explored people’s subjective experience of mental illness with the aim of identifying factors related to their views of mental illness, their adaptation, coping and recovery, and the subjective meanings they gave to the phenomenon. In Phase I, 25 adults diagnosed with mental illness participated in unstructured, confidential interviews at the end of which they completed the Recovery Assessment Scale-Revised (RAS-R) (Corrigan et al., 1999). The study identified six main themes related to person-centred and social/relational factors that played a role in the persons’ life with mental illness: (a) mental illness as a journey, (b) personal conceptualisations of mental illness, (c) illness management and coping, (d) losses and gains, (e) professional help, and (f) the role of others. Phase II was completed by 18 participants from the original sample who were provided with feedback on their respective RAS-R (Corrigan et al., 1999) results and who in turn provided their feedback on the scale and their experience of completing it; this was followed by a discussion of recovery. The participant narratives suggested that recovery was conceptualised in two broad ways: as a return to baseline following crisis and as living as best as one can given personal circumstances. The findings further indicated that recovery as a concept had the potential to remain abstract and lack in meaning unless the person’s biases and perceptions were explored in an opened, non-directive conversation. Both the initial interview and the follow-up session were audiotaped, transcribed and consequently subjected to thematic content analysis. Following the analysis, the participants were invited for a third interview during which they were asked to provide feedback on the analysis and add further information. This represented Phase III, which ii was completed by 10 participants from the original sample; this phase also served as a reflection on the experience of research participation. Findings indicated that research participation was generally seen as a positive experience that could have potentially therapeutic benefits. The process involved active engagement for both the participants and the researcher, which may have helped foster closeness but that also raised a number of ethical dilemmas, primarily in terms of dual roles and researcher self- disclosure. Overall, the studies highlighted the complex interplay of both clinical and non-clinical factors that the individuals took into account as they were making sense of their experience. The studies have a number of clinical implications, specifically addressing the role of hospitals in treatment, the relationship between mental illness and trauma, participatory assessment of recovery, and the role of clinical psychology in the treatment of severe mental illness. Furthermore, the studies point out the potential benefits of supplementing clinical work, whether in research or in treatment, with the methods and processes of Gadamerian hermeneutics. The core principles of the Gadamerian approach (the fusion of the horizons of meaning, the hermeneutic circle and the dialogue) promote viewing of a phenomenon as a contextually embedded experience that is interpreted through the person’s pre-existing views and his/her present range of vision. The approach conceptualises interactions between two parties as opened conversations that aim at shared understanding, rather than objective truth. Such conversations are characterised by a back-and-forth movement between the whole and its parts, which eventually leads to improved understanding. Therefore greater appreciation of contextual information and meaning- making processes; treating both sources of expertise (consumer and professional) as equally important; viewing psychopathology as only one part of mental illness and mental illness as one part of the person’s life; and finally approaching clinical and research interactions as relational endeavours that test the underlying assumptions of both parties could help influence the way mental health professionals work with individuals with severe mental illness. iii Declaration I certify that this thesis does not, to the best of my knowledge and belief: i. incorporate without acknowledgment any material previously submitted for a degree or diploma in any institution of higher education; ii. contain any material previously published or written by another person except where due reference is made in the text of this thesis; or iii. contain any defamatory material. iv Acknowledgment My biggest thanks and gratitude go to the men and women who took their time to participate in my research and generously share their stories. Their courage and willingness to open up has left me determined to do my best as a person and as a professional. I would also like to thank the staff and members of the Lorikeet and June O’Connor centres for their discussions and for always making me feel welcome. Next, I want to thank my supervisor, Dr. Ken Robinson, for his help, encouragement and mentorship. Great thanks to Rachel French for helping me improve my writing, and to my critical reader, Dr Jennifer Loh, for her valuable feedback. Finally, I would never have been able to complete this project without the love and support from my family and friends. Special thanks go to Phill, for his patience and for always believing in me, and to my boys, William and Samuel, for keeping things in perspective and for reminding me that there is life outside the PhD. v TABLE OF CONTENTS Abstract ................................................................................................................................... ii Declaration ............................................................................................................................. iv Acknowledgment .................................................................................................................... v CHAPTER 1 Introduction and overview of the thesis ............................................................................... 1 CHAPTER 2 Literature review .................................................................................................................. 10 Recovery ................................................................................................................................. 12 Definition and conceptualization ....................................................................................... 13 How people recover ............................................................................................................ 17 Assessing recovery ............................................................................................................. 20 Recovery-oriented care ....................................................................................................... 24 Recovery-oriented interventions and programs. ............................................................. 25 Recovery-oriented treatment. ......................................................................................... 26 System transformation. ................................................................................................... 28 Summary and rationale for the present studies ....................................................................... 29 CHAPTER 3 Method ................................................................................................................................... 34 Design ................................................................................................................................. 34 Overview ............................................................................................................................ 38 Pilot study: Case studies. ................................................................................................ 38 Phase I: Exploration of the lived experience of people diagnosed with mental illness .. 39 Phase II: Feedback on the Recovery Assessment Scale and exploration of recovery. ... 40 Phase III: Follow-up interview. ...................................................................................... 41 Sample ................................................................................................................................ 42 Procedure ............................................................................................................................ 44 Establishing trustworthiness ............................................................................................... 46 Ethics .................................................................................................................................. 46 Analysis 47 vi

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